Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model

Obesity Surgery

Volumn 25, Issue 9, 2015, Pages 1559-1568

  Borisenko, Oleg ^a   Adam, Daniel ^a   Funch Jensen, Peter ^b   Ahmed, Ahmed R ^c   Zhang, Rongrong ^a   Colpan, Zeynep ^a   Hedenbro, Jan ^d  

^a Synergus AB   (Sweden)

^b AARHUS UNIVERSITY HOSPITAL   (Denmark)

^c IMPERIAL COLLEGE LONDON   (United Kingdom)

^d LUND UNIVERSITY   (Sweden)

Author keywords

Bariatric surgery; Cost; Cost effectiveness analysis; Cost utility analysis; Health economics; Sweden

Indexed keywords

ADULT; AGED; ARTICLE; BARIATRIC SURGERY; BODY MASS; CLINICAL ARTICLE; CONSERVATIVE TREATMENT; COST CONTROL; COST UTILITY ANALYSIS; DIABETIC PATIENT; FEMALE; GASTRIC BANDING; HEALTH CARE SYSTEM; HOSPITAL ADMISSION; HUMAN; MALE; NON INSULIN DEPENDENT DIABETES MELLITUS; PRIORITY JOURNAL; QUALITY ADJUSTED LIFE YEAR; RISK ASSESSMENT; RISK REDUCTION; SENSITIVITY ANALYSIS; SLEEVE GASTRECTOMY; STOMACH BYPASS; TRANSIENT ISCHEMIC ATTACK; COST BENEFIT ANALYSIS; DIABETES MELLITUS, TYPE 2; ECONOMICS; EUROPE; ISCHEMIC ATTACK, TRANSIENT; MARKOV CHAIN; MIDDLE AGED; OBESITY, MORBID;

ADULT; AGED; BARIATRIC SURGERY; COST SAVINGS; COST-BENEFIT ANALYSIS; DIABETES MELLITUS, TYPE 2; EUROPE; FEMALE; HUMANS; ISCHEMIC ATTACK, TRANSIENT; MALE; MARKOV CHAINS; MIDDLE AGED; OBESITY, MORBID; QUALITY-ADJUSTED LIFE YEARS; WAITING LISTS;

EID: 84938423459     PISSN: 09608923     EISSN: 17080428     Source Type: Journal    
DOI: 10.1007/s11695-014-1567-5     Document Type: Article

References (91)

1. Padwal R, Li SK, Lau DC. Long-term pharmacotherapy for obesity and overweight. Cochrane Database Syst Rev. 2004;3:CD004094. doi:10.1002/14651858.CD004094.pub2.
2. Shaw K, Gennat H, O’Rourke P, Del Mar C. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006;4:CD003817. doi:10.1002/14651858.CD003817.pub3.
3. Shaw K, O’Rourke P, Del Mar C, Kenardy J. Psychological interventions for overweight or obesity. Cochrane Database Syst Rev. 2005;2:CD003818. doi:10.1002/14651858.CD003818.pub2.
4. Drummond MF, Sculpher M, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. Thirdth ed. Oxford: Oxford University Press; 2005.
5. D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743–53. doi:10.1161/circulationaha.107.699579.
6. Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease risk profiles. Am Heart J. 1991;121(1 Pt 2):293–8.
7. Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190. doi:10.3310/hta13410. 215–357, iii-iv.
8. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995;122(7):481–6.
9. Sjostrom L. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.
10. Birkmeyer NJ, Dimick JB, Share D, Hawasli A, English WJ, Genaw J, et al. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304(4):435–42. doi:10.1001/jama.2010.1034.
11. Finks JF, Kole KL, Yenumula PR, English WJ, Krause KR, Carlin AM, et al. Predicting risk for serious complications with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Ann Surg. 2011;254(4):633–40. doi:10.1097/SLA.0b013e318230058c.
12. Scandinavian Obesity Surgery Registry. Annual Report 2011. [cited 2014 September 20]. Available from: http://www.ucr.uu.se/soreg/index.php/dokument/cat_view/58-dokument/57-arsrapporter.
13. Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA J Am Med Assoc. 2012;307(1):56–65. doi:10.1001/jama.2011.1914.
14. OECD. OECD Factbook 2011: Economic, Environmental and Social Statistics 2011. [cited 2014 September 20]. Available from: http://www.oecd-ilibrary.org/economics/oecd-factbook_18147364.
15. Henriksson F, Agardh CD, Berne C, Bolinder J, Lönnqvist F, Stenström P, et al. Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med. 2000;248(5):387–96.
16. Ghatnekar O, Persson U, Glader EL, Terént A. Cost of stroke in Sweden: an incidence estimate. Int J Technol Assess Health Care. 2004;20(3):375–80.
17. Henriksson M, Russell D, Bodegard J, Kjeldsen S, Hasvold P, Stålhammar J, et al. Health-care costs of losartan and candesartan in the primary treatment of hypertension. J Hum Hypertens. 2011;25(2):130–6. doi:10.1038/jhh.2010.36.
18. Wilhelmsen L, Welin L, Odén A, Björnberg A. Saving lives, money and resources: drug and CABG/PCI use after myocardial infarction in a Swedish record-linkage study. Eur J Health Econ. 2010;11(2):177–84. doi:10.1007/s10198-009-0161-6.
19. Agvall B, Borgquist L, Foldevi M, Dahlström U. Cost of heart failure in Swedish primary healthcare. Scand J Prim Health Care. 2005;23(4):227–32. doi:10.1080/02813430500197647.
20. Levy E, Gabriel S, Dinet J. The comparative medical costs of atherothrombotic disease in European countries. Pharmacoeconomics. 2003;21(9):651–9.
21. Andersson F, Kartman B. The cost of angina pectoris in Sweden. Pharmacoeconomics. 1995;8(3):233–44.
22. Statistics Sweden. Consumer Price Index (CPI) 2012 [cited 2014 September 20]. Available from: http://www.scb.se/Pages/TableAndChart____272152.aspx.
23. Gray A, Clarke P, Wolstenholme J, and Wordsworth S. Applied Methods of Cost-effectiveness Analysis in Healthcare. Oxford: Oxford University Press; 2010.
24. OECD. Purchasing Power Parities for GDP and related indicators. [cited 2014 September 20]. Available from: http://stats.oecd.org/index.aspx?DataSetCode=PPPGDP
25. Ackroyd R, Mouiel J, Chevallier JM, Daoud F. Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg. 2006;16(11):1488–503. doi:10.1381/096089206778870067.
26. Sullivan PW, Slejko JF, Sculpher MJ, Ghushchyan V. Catalogue of EQ-5D scores for the United Kingdom. Med Decis Making Int J Soc Med Decis Making. 2011;31(6):800–4. doi:10.1177/0272989X11401031.
27. Edling A, Stenberg A. General guidelines for economic evaluations from the Pharmaceutical Benefits Board (LFNAR 2003:2). 2003.
28. Belgian Health Care Knowledge Centre. Threshold values for cost-effectiveness in health care. KCE reports 100 C. 2008.
29. Persson U, Nordling S, Pettersson B. Kostnadseffektivitetsanalyser – ett instrument för en långsiktigt hållbar läkemedelsmarknad? Kostnadseffektivitetsanalyser. 2009.
30. Hjalte K, Hjelmgren J, Johansson F, Persson U. Betalningsviljan för ett kvalitetsjusterat levnadsår − en pilotstudie. IHE Lund. 2005.
31. Briggs A, Sculpher M, and Claxton K. Decision Modelling for Health Economic Evaluation. Oxford: Oxford University Press; 2006.
32. National Institute for Health and Care Excellence. Guide to the methods of technology appraisal 2008.
33. Institute for Quality and Efficiency in Health Care. General Methods for the Assessment of the Relation of Benefits to Costs. Version 1.0. 2009.
34. Canadian Agency for Drugs and Technologies in Health. Guidelines for the Economic Evaluation of Health Technologies. 2006.
35. Keating CL, Dixon JB, Moodie ML. Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modeled lifetime analysis. Diabetes Care. 2009;32(4):567–74. doi:10.2337/dc08-1749.
36. Wang BCM, Wong ES, Alfonso-Cristancho R, He H, Flum DR, Arterburn DE, et al. Cost-effectiveness of bariatric surgical procedures for the treatment of severe obesity. Eur J Health Econ. 2013. doi:10.1007/s10198-013-0472-5.
37. Campbell J, McGarry LA, Shikora SA, Hale BC, Lee JT, Weinstein MC. Cost-effectiveness of laparoscopic gastric banding and bypass for morbid obesity. Am J Manage Care. 2010;1(16):e174–87.
38. Ikramuddin S, Klingman D, Swan T, Minshall ME. Cost-effectiveness of Roux-en-Y gastric bypass in type 2 diabetes patients. Am J Manage Care. 2009;15(9):607–15.
39. Hoerger TJ, Zhang P, Segel JE, Kahn HS, Barker LE, Couper S. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care. 2010;33(9):1933–9. doi:10.2337/dc10-0554.
40. Faria GR, Preto JR, Costa-Maia J. Gastric bypass is a cost-saving procedure: results from a comprehensive Markov model. Obes Surg. 2013;23(4):460–6. doi:10.1007/s11695-012-0816-8.
41. Anselmino M, Bammer T, Fernández Cebrián JM, Daoud F, Romagnoli G, Torres A. Cost-effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries(II). Obes Surg. 2009 Nov;19(11):1542-9. doi:10.1007/s11695-009-9946-z.
42. Lee YY, Veerman JL, Barendregt JJ. The cost-effectiveness of laparoscopic adjustable gastric banding in the morbidly obese adult population of Australia. PLoS One. 2013 May 22;8(5):e64965. doi:10.1371/journal.pone.0064965.
43. Christou NV, Efthimiou E. Bariatric surgery waiting times in Canada. Can J Surg. 2009;52(3):229–34.
44. Padwal R, Klarenbach S, Wiebe N, Hazel M, Birch D, Karmali S, et al. Bariatric surgery: a systematic review of the clinical and economic evidence. J Gen Intern Med. 2011;26(10):1183–94. doi:10.1007/s11606-011-1721-x.
45. Gregory DM, Temple Newhook J, Twells LK. Patients’ perceptions of waiting for bariatric surgery: a qualitative study. Int J Equity Health. 2013;12(1):86. doi:10.1186/1475-9276-12-86.
46. Padwal RS, Majumdar SR, Klarenbach S, Birch DW, Karmali S, McCargar L, et al. Health status, quality of life, and satisfaction of patients awaiting multidisciplinary bariatric care. BMC Health Serv Res. 2012;12:139. doi:10.1186/1472-6963-12-139.
47. Mäklin S, Malmivaara A, Linna M, Victorzon M, Koivukangas V, Sintonen H. Cost-utility of bariatric surgery for morbid obesity in Finland. Br J Surg. 2011;98(10):1422–9. doi:10.1002/bjs.7640.
48. Pollock RF, Muduma G, Valentine WJ. Evaluating the cost-effectiveness of laparoscopic adjustable gastric banding versus standard medical management in obese patients with type 2 diabetes in the UK. Diabetes Obes Metab. 2013;15:121–9.
49. Roubík L, Borovský J. Assessment of morbid obesity treatment cost efficiency in the Czech Republic. Metabolismus. 2012;15(3):201–6.
50. Nguyen NT, Slone JA, Nguyen X-MT, Hartman JS, Hoyt DB. A prospective randomized trial of laparoscopic gastric bypass versus laparoscopic adjustable gastric banding for the treatment of morbid obesity: outcomes, quality of life, and costs. Ann Surg. 2009;250(4):631–41. doi:10.1097/SLA.0b013e3181b92480.
51. Ewing BT, Thompson MA, Wachtel MS, Frezza EE. A cost-benefit analysis of bariatric surgery on the South Plains region of Texas. Obes Surg. 2011;21(5):644–9. doi:10.1007/s11695-010-0266-0.
52. Keating CL, Peeters A, Swinburn B, Carter R, Moodie ML. Pharmaceutical utilisation and costs before and after bariatric surgery. Int J Obes. 2013;37(11):1467–72. doi:10.1038/ijo.2013.24.
53. Finkelstein EA, Allaire BT, DiBonaventura MD, Burgess SM. Direct and indirect costs and potential cost savings of laparoscopic adjustable gastric banding among obese patients with diabetes. J Occup Environ Med. 2011;53(9):1025–9. doi:10.1097/JOM.0b013e318229aae4.
54. Keating CL, Dixon JB, Moodie ML, Peeters A, Playfair J, O’Brien PE. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care. 2009;32(4):580–4. doi:10.2337/dc08-1748.
55. Ghiassi S, Morton J, Bellatorre N, Eisenberg D. Short-term medication cost savings for treating hypertension and diabetes after gastric bypass. Surg Obes Relat Dis. 2012;8(3):269–74. doi:10.1016/j.soard.2011.05.009.
56. Ojo P, Valin E. Cost-effective restrictive bariatric surgery: laparoscopic vertical banded gastroplasty versus laparoscopic adjustable gastric band. Obes Surg. 2009;19(11):1536–41. doi:10.1007/s11695-008-9771-9.
57. Neovius M, Narbro K, Keating C, Peltonen M, Sjöholm K, Agren G, et al. Health care use during 20 years following bariatric surgery. JAMA. 2012;308(11):1132–41. doi:10.1001/2012.jama.11792.
58. Ramos-Levi AM, Matia P, Cabrerizo L, Barabash A, Sanchez-Pernaute A, Calle-Pascual AL, et al. Statistical models to predict type 2 diabetes remission after bariatric surgery. J Diabetes. 2014. doi:10.1111/1753-0407.12127.
59. Lee YC, Lee WJ, Liew PL. Predictors of remission of type 2 diabetes mellitus in obese patients after gastrointestinal surgery. Obes Res Clin Pract. 2013;7(6):e494–500. doi:10.1016/j.orcp.2012.08.190.
60. Still CD, Wood GC, Benotti P, Petrick AT, Gabrielsen J, Strodel WE, et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol. 2014;2(1):38–45. doi:10.1016/s2213-8587(13)70070-6.
61. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS)–explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health. 2013;16(2):231–50. doi:10.1016/j.jval.2013.02.002.
62. Ikramuddin S. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes hypertension and hyperlipidemia: the Diabetes Surgery Study Randomized Clinical Trial. JAMA. 2013;309(21):2240–9.
63. Ikramuddin S, Korner J, Lee WJ, Connett JE, Inabnet WB, Billington CJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study Randomized Clinical Trial. JAMA. 2013;309(21):2240–9. doi:10.1001/jama.2013.5835.
64. Schauer P, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.
65. Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis. 2007;3(2):127–32. doi:10.1016/j.soard.2006.12.005. discussion 32–3.
66. Stoeckli R, Chanda R, Langer I, Keller U. Changes of body weight and plasma ghrelin levels after gastric banding and gastric bypass. Obes Res. 2004;12(2):346–50. doi:10.1038/oby.2004.43.
67. Bessler M, Daud A, Kim T, DiGiorgi M. Prospective randomized trial of banded versus nonbanded gastric bypass for the super obese: early results. Surg Obes Relat Dis Off J Am Soc Bariatric Surg. 2007;3(4):480–4. doi:10.1016/j.soard.2007.01.010. discussion 4–5.
68. Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7. doi:10.1097/SLA.0b013e318156f012.
69. Dixon JB, Brien PEO, Playfair J, Chapman L, Schachter LM, Skinner S, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes. JAMA. 2008;299(3):316–23.
70. van Dielen FMH, Soeters PB, de Brauw LM, Greve JWM. Laparoscopic adjustable gastric banding versus open vertical banded gastroplasty: a prospective randomized trial. Obes Surg. 2005;15(9):1292–8. doi:10.1381/096089205774512456.
71. Mathus-Vliegen EMH, de Wit LT. Health-related quality of life after gastric banding. Br J Surg. 2007;94(4):457–65. doi:10.1002/bjs.5607.
72. Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, et al. Interdisciplinary European guidelines on surgery of severe obesity. Obes Facts. 2008;1(1):52–9. doi:10.1159/000113937.
73. Sjukvårdsregionen Västra Götaland. Utomlänspriser. 2012.
74. Bolin K, Gip C, Mörk AC, Lindgren B. Diabetes, healthcare cost and loss of productivity in Sweden 1987 and 2005—a register-based approach. Diabet Med. 2009;26(9):928–34. doi:10.1111/j.1464-5491.2009.02786.x.
75. Lindgren P, Glader EL, Jönsson B. Utility loss and indirect costs after stroke in Sweden. Eur J Cardiovasc Prev Rehabil. 2008;15(2):230–3. doi:10.1097/HJR.0b013e3282f37a22.
76. Zethraeus N, Molin T, Henriksson P, Jönsson B. Costs of coronary heart disease and stroke: the case of Sweden. J Intern Med. 1999;246(2):151–9.
77. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366(9489):895–906. doi:10.1016/S0140-6736(05)67185-1.
78. Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, Coday M, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–54. doi:10.1056/NEJMoa1212914.
79. Cushman WC, Evans GW, Byington RP, Goff DC, Grimm RH, Cutler JA, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575–85. doi:10.1056/NEJMoa1001286.
80. Wolf PA, D’Agostino RB, O’Neal MA, Sytkowski P, Kase CS, Belanger AJ, et al. Secular trends in stroke incidence and mortality. The Framingham Study. Stroke. 1992;23(11):1551–5.
81. Dennis MS, Burn JP, Sandercock PA, Bamford JM, Wade DT, Warlow CP. Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke. 1993;24(6):796–800.
82. Witt BJ, Ballman KV, Brown RD, Meverden RA, Jacobsen SJ, Roger VL. The incidence of stroke after myocardial infarction: a meta-analysis. Am J Med. 2006;119(4):354. doi:10.1016/j.amjmed.2005.10.058. e1-9.
83. Ovbiagele B, Diener HC, Yusuf S, Martin RH, Cotton D, Vinisko R, et al. Level of systolic blood pressure within the normal range and risk of recurrent stroke. JAMA. 2011;306(19):2137–44. doi:10.1001/jama.2011.1650.
84. Rosengren A, Wilhelmsen L, Hagman M, Wedel H. Natural history of myocardial infarction and angina pectoris in a general population sample of middle-aged men: a 16-year follow-up of the Primary Prevention Study, Göteborg, Sweden. J Intern Med. 1998;244(6):495–505.
85. Zanchetti A, Hansson L, Dahlöf B, Elmfeldt D, Kjeldsen S, Kolloch R, et al. Effects of individual risk factors on the incidence of cardiovascular events in the treated hypertensive patients of the Hypertension Optimal Treatment Study. HOT study group. J Hypertens. 2001;19(6):1149–59.
86. Krumholz HM, Merrill AR, Schone EM, Schreiner GC, Chen J, Bradley EH, et al. Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission. Circ Cardiovasc Qual Outcomes. 2009;2(5):407–13. doi:10.1161/CIRCOUTCOMES.109.883256.
87. Arnold JM, Yusuf S, Young J, Mathew J, Johnstone D, Avezum A, et al. Prevention of heart failure in patients in the Heart Outcomes Prevention Evaluation (HOPE) study. Circulation. 2003;107(9):1284–90.
88. Velagaleti RS, Pencina MJ, Murabito JM, Wang TJ, Parikh NI, D’Agostino RB, et al. Long-term trends in the incidence of heart failure after myocardial infarction. Circulation. 2008;118(20):2057–62. doi:10.1161/CIRCULATIONAHA.108.784215.
89. Poole-Wilson PA, Lubsen J, Kirwan BA, van Dalen FJ, Wagener G, Danchin N, et al. Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial. Lancet. 2004;364(9437):849–57. doi:10.1016/S0140-6736(04)16980-8.
90. Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med. 1992;326(6):381–6. doi:10.1056/NEJM199202063260605.
91. Hansen LJ, Olivarius NF, Siersma V. 16-year excess all-cause mortality of newly diagnosed type 2 diabetic patients: a cohort study. BMC Public Health. 2009;9:400. doi:10.1186/1471-2458-9-400.